Provider Demographics
NPI:1134510050
Name:JARRY, MICHAEL JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JASON
Last Name:JARRY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2896 CHAMBLEE TUCKER RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4009
Mailing Address - Country:US
Mailing Address - Phone:770-457-0584
Mailing Address - Fax:770-457-0773
Practice Address - Street 1:2896 CHAMBLEE TUCKER RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4009
Practice Address - Country:US
Practice Address - Phone:770-457-0584
Practice Address - Fax:770-457-0773
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor